Pediatric Imperforate Hymen Workup

  • Author: Amulya K Saxena, MD, PhD; Chief Editor: Andrea L Zuckerman, MD   more...
 
Updated: Apr 3, 2012
 

Laboratory Studies

  • Laboratory studies are not necessary in the evaluation and treatment of imperforate hymen.
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Imaging Studies

  • Abdominal and pelvic ultrasonography and MRI are the cornerstones of imaging for uterovaginal anomalies.
  • Ultrasonography provides a reliable means for rapidly diagnosing hematocolpos or hematometrocolpos (see the images below).[12] Sagittal sonogram in an adolescent with imperforatSagittal sonogram in an adolescent with imperforate hymen shows a distended vagina and uterus. Transverse sonogram in an adolescent with imperforTransverse sonogram in an adolescent with imperforate hymen shows a distended vagina immediately posterior to the bladder.
  • If a complex anomaly is suspected, MRI is necessary. In addition, transrectal ultrasonography may help in delineating complex anatomy.
  • MRI and ultrasonography also aid in excluding associated congenital anomalies of the urinary tract.
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Other Tests

  • Invasive examination is typically unnecessary for diagnosis. However, sedation or general anesthesia may considerably aid in the examination of anxious patients, especially young children. In the optimal situation, the use of anesthesia should be delayed until noninvasive studies are completed and until a surgeon is prepared to proceed with definitive therapy.
  • Laparoscopy has been recommended in some cases to evacuate pelvic and intra-abdominal endometrial material generated because of retrograde menstruation. This procedure is speculated to reduce the potential for secondary endometriosis. However, most cases of endometriosis regress spontaneously after resection of the obstructing membrane. Most cases do not require concurrent laparoscopy.
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Diagnostic Procedures

  • Careful physical examination combined with imaging is usually sufficient to establish the diagnosis of imperforate hymen.
  • In certain circumstances related to the child's age and maturity, examination may need to be deferred until it can be performed with the patient under anesthesia.
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Contributor Information and Disclosures
Author

Amulya K Saxena, MD, PhD  Associate Professor, Department of Pediatric and Adolescent Surgery, Medical University of Graz, Austria

Amulya K Saxena, MD, PhD is a member of the following medical societies: Austrian Society for Pediatric and Adolescent Surgery, European Pediatric Surgeons Association, German Society of Pediatric Surgery, German Society of Surgery, International Pediatric Endosurgery Group, and Tissue Engineering and Regenerative Medicine International Society (TERMIS)

Disclosure: Nothing to disclose.

Coauthor(s)

Martin I Herman, MD, FACEP, FAAP  Professor, Department of Pediatrics, Division of Critical Care and Emergency Medicine, University of Tennessee Health Sciences Center; President, Pediatric Emergency Services Specialists, PC; Assistant Medical Director of Emergency Services, LeBonheur Children's Medical Center

Martin I Herman, MD, FACEP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, and Tennessee Medical Association

Disclosure: Challenger COrporation Ownership interest Board membership

Elizabeth A Paton, RN, MSN, NP  CS Nurse Practitioner, Department of Emergency Medicine, Le Bonheur Children's Medical Center

Elizabeth A Paton, RN, MSN, NP is a member of the following medical societies: American Academy of Nurse Practitioners, American Academy of Pediatrics, Emergency Nurses Association, National Association of Pediatric Nurse Practitioners, and Sigma Theta Tau International

Disclosure: Nothing to disclose.

Specialty Editor Board

Elizabeth Alderman, MD  Director of Fellowship Training Program, Director of Adolescent Ambulatory Service, Professor of Clinical Pediatrics, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Children's Hospital at Montefiore

Elizabeth Alderman, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine

Disclosure: Merck Honoraria Speaking and teaching

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

H Biemann Othersen Jr, MD  Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina

H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association

Disclosure: Nothing to disclose.

Chief Editor

Andrea L Zuckerman, MD  Assistant Professor of Obstetrics/Gynecology and Pediatrics, Tufts University School of Medicine; Division Director, Pediatric and Adolescent Gynecology, Tufts Medical Center

Andrea L Zuckerman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of former author Arlet Kurkchubasche, MD, to the development and writing of this article.

References

  1. Ameh EA, Mshelbwala PM, Ameh N. Congenital vaginal obstruction in neonates and infants: recognition and management. J Pediatr Adolesc Gynecol. Apr 2011;24(2):74-8. [Medline].

  2. Wall EM, Stone B, Klein BL. Imperforate hymen: a not-so-hidden diagnosis. Am J Emerg Med. May 2003;21(3):249-50. [Medline].

  3. Goodyear-Smith FA, Laidlaw TM. What is an 'intact' hymen? A critique of the literature. Med Sci Law. Oct 1998;38(4):289-300. [Medline].

  4. Berenson AB. The prepubertal genital exam: what is normal and abnormal. Curr Opin Obstet Gynecol. Dec 1994;6(6):526-30. [Medline].

  5. Congenital abnormalities of the female reproductive tract. In: Mishell DR, Stenchever MA, Droegemueller W, et al, eds. Comprehensive Gynecology. 3rd ed. St Louis, Mo: Mosby-Year Book; 1997.

  6. Stelling JR, Gray MR, Davis AJ, et al. Dominant transmission of imperforate hymen. Fertil Steril. Dec 2000;74(6):1241-4. [Medline].

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  8. Nazir Z, Rizvi RM, Qureshi RN, Khan ZS, Khan Z. Congenital vaginal obstructions: varied presentation and outcome. Pediatr Surg Int. Sep 2006;22(9):749-53. [Medline].

  9. Winderl LM, Silverman RK. Prenatal diagnosis of congenital imperforate hymen. Obstet Gynecol. May 1995;85(5 Pt 2):857-60. [Medline].

  10. Ogunyemi D. Prenatal sonographic diagnosis of bladder outlet obstruction caused by a ureterocele associated with hydrocolpos and imperforate hymen. Am J Perinatol. 2001;18(1):15-21. [Medline].

  11. Ahmed S, Morris LL, Atkinson E. Distal mucocolpos and proximal hematocolpos secondary to concurrent imperforate hymen and transverse vaginal septum. J Pediatr Surg. Oct 1999;34(10):1555-6. [Medline].

  12. Ayaz UY, Dilli A, Api A. Ultrasonographic diagnosis of congenital hydrometrocolpos in prenatal and newborn period: a case report. Med Ultrason. Sep 2011;13(3):234-6. [Medline].

  13. Posner JC, Spandorfer PR. Early detection of imperforate hymen prevents morbidity from delays in diagnosis. Pediatrics. Apr 2005;115(4):1008-12. [Medline]. [Full Text].

  14. Buick RG, Chowdhary SK. Backache: a rare diagnosis and unusual complication. Pediatr Surg Int. 1999;15(8):586-7. [Medline].

  15. Croak A, Gebhard J. Congenital abnormalities of the female urogenital tract. J Pelvic Med Surg. 2005;11(4):165-81.

  16. El-Messidi A, Fleming NA. Congenital imperforate hymen and its life-threatening consequences in the neonatal period. J Pediatr Adolesc Gynecol. Apr 2006;19(2):99-103. [Medline].

  17. Heger AH, Ticson L, Guerra L, et al. Appearance of the genitalia in girls selected for nonabuse: review of hymenal morphology and nonspecific findings. J Pediatr Adolesc Gynecol. Feb 2002;15(1):27-35. [Medline].

  18. Master-Hunter T, Heiman DL. Amenorrhea: evaluation and treatment. Am Fam Physician. Apr 15 2006;73(8):1374-82. [Medline].

  19. Rock JA, Zacur HA, Dlugi AM, et al. Pregnancy success following surgical correction of imperforate hymen and complete transverse vaginal septum. Obstet Gynecol. Apr 1982;59(4):448-51. [Medline].

 
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Embryologic origin of the hymenal membrane.
Neonate with a bulging perineum due to mucocolpos.
Sagittal sonogram in an adolescent with imperforate hymen shows a distended vagina and uterus.
Transverse sonogram in an adolescent with imperforate hymen shows a distended vagina immediately posterior to the bladder.
 
 
 
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